Consultation Visits

Should my patient take out their contact lenses prior to their consultation?

Either way is fine.Some patients do not like going without their contacts, so when they come in for a consultation, we can give them a rough idea of candidacy, and they can proceed from there.Some patients don’t mind removing their contacts for the specified period of time.If that’s the case, when they come in for their consultation, chances are that we will be able to accurately determine candidacy at that visit.

Time out of contacts varies by type of contact lens.Soft spherical daily wear contact lenses should be discontinued for two weeks.Extended wear and soft toric daily wear contact lenses should be discontinued for three weeks.RGP contacts should be discontinued for variable amounts of time.The usual rule of thumb with RGP wear is to discontinue use at 1 month for every decade of wear.

How does TLC Tysons Corner schedule their patients?

Each appointment time slot is reserved for one patient.This allows us the opportunity to carefully work with each patient and answer all of their questions without being rushed.Other places might double book patients in order to maximize their numbers. However, at TLC Tysons Corner, we try to maximize personalized care.

Should I recommend LASIK to my presbyopic patients?

Just like you would not prejudge a patient when they are in your dispensary, you would not prejudge whether or not a patient would like to have refractive surgery.Depending on their individual lifestyles, patients may be willing to use readers in order to gain the freedom of having better distance vision.Additionally, some patients are candidates for monovision correction.

Pre-operative

When should I dilate my patient and what drops are used?

Some doctors like to gather all of their patient information and data prior to sending the patient in for consultation.That’s helpful because we have a completed treatment sheet in the chart already.However, some doctors like to wait until the patient has been approved as a candidate before doing the dilation.That’s helpful to you because it saves you the time of having to perform another refraction if it turns out the patient is not a candidate.

What do I charge a patient for a monovision contact lenses trial?

You should charge whatever you would charge any other patient who wishes to be fit in monovision contact lenses.If we recommend that a patient sees you for a monovision demonstration, we will tell them to expect a contact lens fitting fee for this service.

Where can I get good copies of the TLC pre-operative form?

Surgical

What kind of lasers does Dr. Holzman use?

The Intralase laser is used to create the flap on LASIK patients.

The VISX laser provides a customized wavefront-guided treatment of the cornea.The Allegretto laser provides a wavefront-optimized treatment of the cornea.Dr. Holzman decides which laser he prefers based on each patient’s individual presentation.

Can I observe Dr. Holzman performing actual cases?

Yes, you can!See our "Visit TLC" page for more information. Visit our calendar for a list of surgery days. It is best for you to visit on a surgery day to maximize your visit, although you are welcome to visit at any time that our doors are open.

What is Dr. Holzman’s enhancement rate?

Will my patient be able to meet directly with Dr. Holzman?

Yes, this can be accomplished in two different ways, depending on your patient preference.

If your patient prefers to meet with Dr. Holzman well ahead of the procedure, we can schedule what we call a “Meet and Greet” for sometime between their consultation visit and surgery date.Your patient can also attend one of Dr. Holzman’s in-house educational lectures for patients.

If your patient is OK with meeting Dr. Holzman right before their procedure, then no extra visits are required.Dr. Holzman actually meets personally with ALL of his surgical patients right before their procedure.He explains his expectations of the patient during the procedure in order to obtain optimal results.

Dr. Holzman likes to listen to music while performing surgery.May I send him a mixed tape?

Yes, Dr. Holzman will happily accept submissions on any medium such as vinyl, tape, CD, mp3, and other creative media.Dr. Holzman will be grateful for your musical contributions, even if he has his usual comment.

Post-operative

What if I'm not in the office for my patient's one-day post-op?

The TLC Tysons Corner Clinical Staff will be more than happy to see your patient for the one-day post-op then refer them back to you for all other post-operative care. Your co-management fee does not change because of this.

What is the post-operative patient regimen for each procedure?

What does the typical patient experience after their procedure?

All patients will naturally experience some degree of dryness, glare/halos, and fluctuating vision while they are healing, regardless of their prescriptions.

Generally, low to moderate myopic and myopic astigmats will see quite well starting almost immediately after surgery.Hyperopic patients should be told that their vision will be blurry initially after surgery and then improve as their eyes heal.Presbyopes should expect to use readers for all near tasks immediately following their procedure. Those with higher prescriptions will take longer to heal and reach stability.

What should I be monitoring for at each post-op visit?

LASIK:At the one day visit, be on the lookout for appropriate visual acuities, flap striae, DLK, infection, epithelial defects, and epithelial ingrowth.At the one week visit, be on the lookout for the same things. A pressure check should be done.For one month and onward, be sure to refract your patient and include that info in your post-op report. We use that info to track our numbers. Look for greater stability of vision and comfort.The patient should always be making progress.

PRK:At the one day visit, inquire about pain levels, check the cornea to make sure that there are no signs of infection, and make sure the BCL moves adequately.Remind them at their pain and vision are likely to get slightly worse over the next few days before getting better.At the 4- or 5-day visit, check for signs of infection and remove the BCL if the epithelium is healed appropriately.Your patient may still experience some discomfort that day.If the epithelium is not completely healed or you are unsure if it is completely healed, keep the BCL on and have your patient return in 1-2 days for re-check. At the 11-14 day visit, ensure that the epithelium is stable and check pressures.At the one month visit, check pressures because the patient should still be on a steriod. You should begin refracting now. Refracting any sooner will give you crazy results with lots of cyl which will cause unnecessary heartbreak. Make sure that there are no signs of developing corneal haze.Also, look for greater stability of vision and comfort.Make sure your patient discontinues their topical steroid as previously directly. The patient should always be making progress.

Where can I get good copies of the TLC post-operative form?

Does anyone really look at the copies of my post-op forms that I fax in?

Yes, as Clinical Director, it is Dr. Weigel’s responsibility to review every fax regarding patient care that comes into our office. We use your information to better monitor our refractive goals. Beginning at one month, UCVA, refractions, and BCVA, combined with pre-operative data, go into data banks to build nomograms specific for our Center. Without this important information that only you can provide, we would not be able to ensure accurate results for future patients!

When you send in your post-op results, use the most current post-op form. Be sure to include pertinent information for quick interpretation on our part. If you indicate that the UCVA is 20/40 on the one-day post-op PRK visit and the original rx of -5.00 DS was treated with the Allegretto laser, the TLC Tysons Corner Clinical Staff knows exactly how to interpret your information, and we can file the information into the patient's chart. If you indicate that the UCVA is 20/40, we have to do more research on the patient's case in order to figure out if all is well or not. Was it PRK or LASIK? What was the original rx? What kind of procedure did the patient have? What laser was used? The TLC Tysons Corner Clinical Staff has to fill in the blanks on your post-op form in order to decide if the patient's case has to be brought to the attention of the Clinical Director or Dr. Holzman. Every blank on the form is "pertinent" so it would be ideal to have a completed post-op form for each visit.

If you care about Dr. Weigel's eyes, you will use your very best handwriting on your chart so as to minimize potential eyestrain.

Why wasn’t my patient immediately sent back to me after their procedure?

On the extremely rare occasion that surgical complications are encountered or if the patient requests to be seen at our center for a specified period of time, we will prefer that patients return to TLC for post-operative care.We will do our best to notify you promptly if these unplanned changes occur.When they are released from our care, they will be promptly returned to your office for all further post-operative (without any changes to your co-mx fees) and comprehensive eye care.

How do I manage the post-op BCL?

Timing of removal depends on the procedure.If the flap looks clear on a LASIK patient, you can remove the BCL on the one-day post-op check.If you are unsure, it is OK to keep the BCL on for an additional day or two and have the patient return for recheck/removal.If the patient is having PRK, the BCL usually is not ready for removal until day 3-5 post-op.If you are unsure, it is OK to keep the BCL on for an additional day or two and have the patient return for recheck/removal.

Removal of the BCL might best accomplished using sterilized tweezers with topical anesthesia.Proparacaine OU helps reduce the blink reflex in both eyes, even if you are just removing a BCL from one eye only. The drop also helps to float the BCL which minimizes epithelial damage upon removal. Tweezers ensure minimal disruption of the still delicate epithelium.Plus, it’s fun to break out your foreign body kit.

Some practitioners remove BCLs with their fingers like they would for any other patient. Dr. Holzman says that this OK, assuming you can slide the BCL inferior enough that it is sitting on the conjunctiva when you grasp it. Also, some prefer to NOT use proparacaine at the time of removal so that they can gauge pain levels after removal.

Either which way you do it, do recheck the epithelium AFTER removal. Throw in a drop of Celluvisc after removal, and consider a short course of Muro128 ung qhs for patients with pre-op epithelial disorders like EBMD.

Tell your patients to expect some discomfort or FBS for the balance of the day when the BCL is removed.

Financial

How much does all laser LASIK cost at TLC?

While costs differ based on the patient’s insurance and potential employer contributions, generally it is best to tell your patients that the all laser procedure will cost just under $5,000.This global fee includes the patient's pre-operative, operative, and post-operative care for one year after the surgical date.

Quoting this fee for patients while they are in your office helps us out a lot. When patients know this fee coming into our office, they don't get "sticker shock" when our staff discusses financial aspects of refractive surgery.

How much does CK cost?

How much is my co-management fee?

What happens to my co-mx fee if I don't manage the entire post-op period?

Your co-management fee is not affected should we keep your patient during their initial post-operative period or should you return your patient to us for consultation at any time during the post-operative period.

If you ever have a question about a patient’s post-operative status or progress, feel free to contact us about your concerns or send the patient back to us for consultation.Most patients will not mind returning to TLC Tysons Corner for consultation since they have already been here before.

When is the best time for a consultation if my patient will be using FSA?

The usual last-minute FSA eligibility consultation rush is between October-December.It would be most ideal to have your patient come in August-October to ensure that they are able to discuss their case with us at a normal, non-rushed pace.

Can my patients get financing to help pay for their procedure?

What do I do when my patient wants to shop around for better pricing?

Your single recommendation means quite a bit to patients … and to us!When you express that you have consistently worked closely with TLC Tysons Corner and Dr. Holzman, patients feel secure.Also reference reasons why you have been referring to us for so many years.

Other places might offer lower fees, but as with all things, you get what you pay for.Comparing our service levels with that of other places is sometimes like comparing apples to oranges.

What makes TLC Tysons Corner unique?

Do you provide a translator for my patients who do not speak English?

Some of your TLC Tysons Corner staff members speak other languages besides English. While we do not claim to be fluent, here is a list of who can speak what proficiently:

Dr. Weigel: Mandarin Chinese, Spanish

Dr. Woo: Korean, Spanish

Alina: Russian, Turkish

If your patient is hearing impaired or deaf, we must know about this ahead of time. If given enough lead time, we might be able to arrange for an interpreter. If the patient can bring their own interpreter, the interpreter would ideally be able to communicate verbally with us. (Yes, that has happened before. At another office, a patient came in without an interpreter. She could not speak verbally, and she could not read lips. After we were done with our longest-ever exam, I wrote her a note saying that she had to bring an interpreter with her to her next exam. She brought another person that could not speak or read lips. Not helpful, especially when dealing with surgery.)

How can I become more involved in the TLC Advisory Board?

Contact us to express your desire to serve on the TLC Advisory Board.This program was started many years ago, discontinued, and then brought back this year by Senior Center Manager Kate Walsh.The Advisory Board ensures that we are constantly hearing what our Affiliates Doctor need us to do for them.

What are some of Dr. Vu-Gia’s favorite nicknames?

How can I tell the difference between Drs. Weigel and Woo?

You cannot tell them apart because the old saying is true:All Asians look alike.Ok, not true.Once you get to know us as individuals, you will be able to improve your abilities to distinguish between your clinical team O.D.s and extend your abilities to all other Asians.